直肠癌侧方淋巴结清扫的争议与共识  

Controversies and consensus on lateral lymph node dissection for rectal cancer

作　　者：陆君阳[1] Lu Junyang(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730

出　　处：《国际外科学杂志》2024年第9期577-582,共6页International Journal of Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2023-I2M-C&T-B-026);中央高水平医院临床科研专项(2022-PUMCH-B-005)。

摘　　要：侧方淋巴结转移是中低位直肠癌常见的转移方式,诊断主要依靠影像学检查。东西方国家在直肠癌侧方淋巴结转移的治疗模式上存在明显差异,西方学者主张采用新辅助放化疗控制侧方淋巴结转移,而以日本为代表的东方国家则主张以侧方淋巴结清扫手术作为主要治疗手段。国内外指南和文献中关于直肠癌侧方淋巴结转移的诊断标准、新辅助治疗模式以及侧方淋巴结清扫指征和手术范围仍存在较大争议。本文将根据国内外指南和共识推荐及现有的循证医学证据对直肠癌侧方淋巴结转移和侧方淋巴结清扫手术相关问题进行论述。Lateral lymph node metastasis is a common metastatic pattern in mid-to-low rectal cancer,and diagnosis primarily relies on imaging examination.There are significant differences between Western and Eastern countries in the treatment approach for lateral lymph node metastasis in rectal cancer.Western scholars advocate for the use of neoadjuvant chemoradiotherapy to control lateral lymph node metastasis,while Eastern countries,exemplified by Japan,support lateral lymph node dissection as the primary treatment method.However,there is still considerable controversy in both domestic and international guidelines and literature regarding the diagnostic criteria for lateral lymph node metastasis in rectal cancer,the neoadjuvant treatment regimen,and the indications and extent of lateral lymph node dissection.This article discusses issues related to rectal cancer lateral lymph node metastasis and lateral lymph node dissection based on domestic and international guidelines and consensus recommendations,as well as existing evidence from evidence-based medicine.

关 键 词：直肠肿瘤 结直肠外科手术 肿瘤辅助疗法 侧方淋巴结清扫 侧方淋巴结转移 

分 类 号：R735.37[医药卫生—肿瘤]